A letter from my med student self to me now
Dear Me, MD:
Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never know, sometimes the train derails, and it takes a little longer than expected, so forgive yourself if that is the case. You learned a while back that the fast lane is overrated so never mind months or years. You now have the degree that you worked so tirelessly for; the one they told you that you would never get; the degree that bears the title I know you will probably never feel is real.
So why did...
Source: Kevin, M.D. - Medical Weblog - April 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/danielle-bottalico" rel="tag" > Danielle Bottalico < /a > Tags: Education Medical school Source Type: blogs
Take it from a patient: Naloxone is life saving
“Ice! Ice! I need ice!” Paul yelled, rushing into a store.
It was a skate shop. They looked at him like he was crazy. “Ice! Ice! I need ice!” he continued to yell.
The store employees looked at Paul with a blank stare. They pointed to the restaurant next door and suggested that he try there to get ice.
They had no idea what was going on.
Paul’s girlfriend had overdosed on heroin and wasn’t breathing that well. She was turning blue. Paul knew that he had to get her breathing again, or she might die.
Continue reading ...
Your patients are rating you online: How to respond. Manage your onl...
Source: Kevin, M.D. - Medical Weblog - April 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/casey-grover-and-paul-harper" rel="tag" > Casey Grover, MD and Paul Harper < /a > Tags: Physician Emergency Source Type: blogs
In any situation, listening is always best. Doctors should remember that.
“Wait. When did you say you started that medication?”
“Two weeks ago.”
“And when did you say you started having those symptoms?”
“Uh … about … let me think … it was — two weeks ago.”
This kind of circumstance is my holy grail. It is the ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have been taking medications started by other physicians within the time frame of those symptoms. One of my rules of thumb (I don’t know how the thumb always gets i...
Source: Kevin, M.D. - Medical Weblog - April 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/rob-lamberts" rel="tag" > Rob Lamberts, MD < /a > Tags: Physician Primary care Source Type: blogs
It is not a great time to be a pharmaceutical rep
More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps sometimes had their own reception rooms in medical offices.
By 2011 thanks to drug safety scandals and new methods of marketing, the bloom had fallen off the pharma reps’ roses. The number of prescribers willing to see most reps fell almost 20 percent, the number refusing to see all reps increased by half, and eight million sales calls “could not be compl...
Source: Kevin, M.D. - Medical Weblog - April 24, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/martha-rosenberg" rel="tag" > Martha Rosenberg < /a > Tags: Meds Medications Source Type: blogs
How I went from the bottom to the top 1 percentile on board exams
Most doctors are very bright people. I believe that what often sets apart those who perform well on the job and on exams isn’t raw intelligence but rather the ability to learn effectively.
In the MCAT and USMLE steps 1, 2, and 3, I did poorly and barely passed. In 2009, I took my family medicine in-training exam and fell below the minimum passing score. After taking almost five years away from residency for healing and to run an orphanage in Africa, I returned to residency and quickly improved my performance to the level that I recently scored in the top 1 percent in the country on my in-training exam. My score isn...
Source: Kevin, M.D. - Medical Weblog - April 24, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kenneth-acha" rel="tag" > Kenneth Acha, MD < /a > Tags: Education Residency Source Type: blogs
Does telemedicine save or cost money?
Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls this cost savings into question. Increased convenience can increase utilization, which may improve access, but not reduce costs.
The study has some obvious limitations. First of all, it followed patients who used one particular telehealth service for one specific cluster of disease (“respiratory illness”) and narrowed the cost measure to spending on that condition ...
Source: Kevin, M.D. - Medical Weblog - April 24, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/val-jones" rel="tag" > Val Jones, MD < /a > Tags: Physician Primary care Source Type: blogs
The importance of a doctors ’ union in the age of Gorsuch
Before I started my residency program at Boston Medical Center (BMC), I had no idea that residents were unionized at 60 hospitals across the country. I actually didn’t know much about unions or the labor movement until I got involved in contract negotiations between my own union, the Committee of Interns and Residents (CIR), and Boston Medical Center administration. Through this process, I now know what it is like to really be part of a union and I am proud to say I am a union member. Here’s why:
Unions have collective power culminating in one voice.
That means the more members we have in our union, the more power we h...
Source: Kevin, M.D. - Medical Weblog - April 24, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/amir-meiri" rel="tag" > Amir Meiri, MD < /a > Tags: Physician Residency Source Type: blogs
Why physicians are anxious today
Recently, I heard from a student in her third year of medical school. To date, she has borrowed more than $100,000 to fund her education. She is in the top 10% of her class, with honors in all of her subjects and high scores on her national exams. She would be a valued resident in the most competitive specialty training programs. Her goal is to become a primary care physician and offer her expertise to a diverse set of patients, leveraging the multiple languages she speaks fluently. But because she was born in a Middle Eastern country, she has a problem.
She wrote to me that she suddenly faces uncertainty about her status ...
Source: Kevin, M.D. - Medical Weblog - April 23, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/robert-pearl" rel="tag" > Robert Pearl, MD < /a > Tags: Physician Primary care Source Type: blogs
A toddler, his dad, and the unthinkable
The toddler was a curious, rambunctious, talkative three-year-old who loved to explore.
Every week, he’d wait for Sunday to come, because Sunday was he and his dad’s special day. Mikey and his father adored each other.
Whether Mikey and his dad were doing “horseback rides,” playing basketball, or just sitting on the rocking chair for story time, whenever they were together there was fun, love and a forever bond.
Mom called them “the twins.”
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 23, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/debbie-moore-black" rel="tag" > Debbie Moore-Black, RN < /a > Tags: Physician Pediatrics Source Type: blogs
What patients want isn ’t always what they need
One of the nurses knocked on my door on a quiet Monday morning.
“Hey, can you see this patient? I guess it’s not urgent but he’s here now, and I think what the doctor told him just threw him for a loop.”
Of course I had time. In my role as clinical nurse specialist in a busy uro-oncology unit, I see men who need help making a treatment decision for management of their prostate cancer. As we walked towards the clinic room where the patient was waiting, the nurse filled me in on what had transpired. The patient, a man in his early 60s, had been diagnosed with high-risk prostate cancer. He had come to see the urologis...
Source: Kevin, M.D. - Medical Weblog - April 23, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/anne-katz" rel="tag" > Anne Katz, RN, PhD < /a > Tags: Physician Cancer Source Type: blogs
A cancer scare changed my life in 7 seconds
So there I was — in deep denial. Maybe you’ve been there: Ignoring the symptoms. Hoping and praying that it would just “go away.”
A little knowledge is a dangerous thing. And as a doctor, I like to think I can Google with the best of them.
So when I had a persistent scary symptom (full disclosure: it was bloody discharge from my left breast. Not subtle. Not intermittent. Not OK, even a little), I finally bit the bullet.
I called my friend and world-renowned breast cancer surgeon, Joe. I’d known Joe for years. I interviewed him for my book on burnout and scrubbed alongside him in the O.R.
Continue reading ...
You...
Source: Kevin, M.D. - Medical Weblog - April 23, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/starla-fitch" rel="tag" > Starla Fitch, MD < /a > Tags: Physician Cancer Source Type: blogs
Providers and patients must listen to the evidence
There is an interesting article from ProPublica called “When Evidence Says No, but Doctors say Yes” making the rounds. It’s about the number of doctors who disbelieve, don’t know or don’t care about medical evidence to the detriment of patients. I do not find any fault with the article. I rail against this daily. I have my whole professional life. It is actually a big reason why I blog because I regularly hear: “I didn’t know that,” from providers or “If I had only known,” from patients. I love when people tell me they took in something I wrote to show their provider. I love when a doctor tells ...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jennifer-gunter" rel="tag" > Jennifer Gunter, MD < /a > Tags: Physician Primary care Source Type: blogs
Don ’t let kids use tanning beds
4.9 million — yes, million — people are diagnosed with skin cancer every year in the United States. It costs an estimated $8.1 billion —with a “B — to treat those skin cancers, according to the Centers for Disease Control (CDC).
Do I have your attention? I hope so. The problem is we don’t have enough attention. There is no other way to explain why too many states still allow those under 18 to access tanning beds across this country.
Have we made progress? Yes, but not nearly enough according to a research paper and editorial published today in JAMA Dermatology.
Continue reading ...
Your patients are rating you...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/j-leonard-lichtenfeld" rel="tag" > J. Leonard Lichtenfeld, MD < /a > Tags: Conditions Cancer Dermatology Source Type: blogs
Watch what you say to patients
Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures.
If you are a heart rhythm doctor, this is a familiar scenario:
Your patient (we’ll assume a male for the sake of pronoun economy) has premature ventricular complexes (PVCs). Not a lot of them, but he feels e...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/david-mann" rel="tag" > David Mann, MD < /a > Tags: Physician Heart Source Type: blogs
MKSAP: 68-year-old man with new-onset ascites
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, and metoprolol.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 122/84 mm Hg, pulse rate is 64/min, and respiration rate is 16/...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs
